Bradley N. Gaynes, MD, MPH; Suzanne L. West, PhD; Carol A. Ford, MD; Paul Frame, MD; Jonathan Klein, MD, MPH; Kathleen N. Lohr, PhD
Acknowledgments: The authors thank David Atkins, MD, MPH, Chief Medical Officer of the Agency for Healthcare Research and Quality Center for Practice and Technology Assessment, and Jean Slutsky, PA, MSPH, Agency for Healthcare Research and Quality Task Order Officer for the USPSTF project. They appreciate the considerable support and contributions of members of the RTI International staff: Sonya Sutton, BSPH, and Loraine Monroe. In addition, they thank the staff from the University of North Carolina at Chapel Hill and the Cecil G. Sheps Center for Health Services Research: Carol Krasnov for administrative assistance and coordination and Timothy S. Carey, MD, MPH, Director of the Sheps Center and Co-Director of the RTI International–University of North Carolina Evidence-based Practice Center.
Grant Support: By contract 290-97-0011 from the Agency for Healthcare Research and Quality (Task No. 3).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (www.preventiveservices.ahrq.gov) and through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295).
Current Author Addresses: Dr. Gaynes: Department of Psychiatry, CB 7160, University of North Carolina, Chapel Hill, NC 27599.
Dr. West: The North Carolina Program for Women's Health Research, Cecil G. Sheps Center for Health Services Research, 725 Airport Road, CB 7590, University of North Carolina, Chapel Hill, NC 27599-7590.
Dr. Ford: Adolescent Medicine Program, CB 7220, University of North Carolina, Chapel Hill, NC 27599-7220.
Dr. Frame: Tri-County Family Medicine, 25 Park Avenue, PO Box 112, Cohocton, NY 14826.
Dr. Klein: Department of Adolescent Medicine, University of Rochester, 601 Elmwood Avenue, Box 690, Rochester, NY 14642.
Dr. Lohr: RTI International, 3040 Cornwallis Road, PO Box 21294, Research Triangle Park, NC 27709-2194.
Suicide is the 11th leading cause of death and the seventh leading cause of years of potential life lost in the United States. Although suicide is of great public health significance, its clinical management is complicated.
The authors systematically reviewed the literature to determine whether screening for suicide risk in primary care settings decreases morbidity, mortality, or both.
MEDLINE (1966 to 17 October 2002), PsycINFO, Cochrane databases, hand-searched bibliographies, and experts.
For screening, only English-language studies performed in primary care settings were examined. For treatment, randomized, controlled trials and cohort studies were included if they were performed in any setting where suicide completions, suicide attempts, or suicidal ideation were reported.
A primary reviewer abstracted data on key variables of study sample, design, and outcomes; a second reviewer checked information accuracy against the original articles.
No study directly addressed whether screening for suicide in primary care reduces morbidity and mortality. The remainder of the review focused on the questions of reliable screening tests for suicide risk and the effectiveness of interventions to decrease depression, suicidal ideation, and suicide attempts or completion. One screening study provided limited evidence for the accuracy of suicide screening in a primary care setting. Intervention studies provided fair and mixed evidence that treating those at risk for suicide reduces the number of suicide attempts or completions. The evidence suggests mild to moderate improvement for interventions addressing intermediate outcomes such as suicidal ideation, decreased depressive severity, decreased hopelessness, or improved level of function.
Because of the complexity of studying the risk for suicide and the paucity of well-designed research studies, only limited evidence guides the primary care clinician's assessment and management of suicide risk.
Key questions (KQs).
Table 1. Randomized, Controlled Trials of Interventions To Decrease Deliberate Self-Harm in Adults and Older Adolescents
Table 2. Additional Randomized, Controlled Trials of Interventions To Reduce Deliberate Self-Harm in Adults and Older Adolescents
Table 3. Cohort Studies To Decrease Suicidal Behavior in At-Risk Patients
Table 4. Previous Review of Randomized, Controlled Trials Comparing Problem-Solving Therapy with Standard Aftercare for Intermediate Outcomes
Table 5. Additional Studies Involving Intermediate Outcomes
Appendix Table 1. Key Questions for Screening for Suicide Risk
Appendix Table 2. Inclusion and Exclusion Criteria
Appendix Table 3. Literature Search Results
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Gaynes BN, West SL, Ford CA, Frame P, Klein J, Lohr KN. Screening for Suicide Risk in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140:822-835. doi: 10.7326/0003-4819-140-10-200405180-00015
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Published: Ann Intern Med. 2004;140(10):822-835.
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